Procedure code and Description
93970 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY
93971 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY
Non-Invasive Peripheral Venous Studies Coding Information
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
11x Hospital Inpatient (Including Medicare Part A)
12x Hospital Inpatient (Medicare Part B only)
13x Hospital Outpatient
18x Hospital – Swing Beds
21x Skilled Nursing – Inpatient (Including Medicare Part A)
22x Skilled Nursing – Inpatient (Medicare Part B only)
23x Skilled Nursing – Outpatient
28x Skilled Nursing – Swing Beds
83x Ambulatory Surgery Center
85x Critical Access Hospital
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
0921 Other Diagnostic Services – Peripheral Vascular Lab
CPT/HCPCS Codes
93965 Extremity study
93970 Extremity study
93971 Extremity study
G0365 Vessel mapping hemo access
Fee amount
HCPC Modifier Short description Non-hospital allowance (physician fee schedule) Hospital allowance (APC rate)
93970 Extremity study (bilateral) $240.32
93970 26 Extremity study $34.64
93970 TC Extremity study $205.68 $155.07
93971 Extremity study (unilateral or limited) $158.77
93971 26 Extremity study $23.45
93971 TC Extremity study $135.32 $97.29
NCCI Edit
The below codes are would not be paid seperately if submitted with CPT 93970
76881 76882 76937 76998 93971 G0365
ICD 10 CODE
D68.51 Activated protein C resistance
D68.52 Prothrombin gene mutation
D68.59 Other primary thrombophilia
D68.61 Antiphospholipid syndrome
D68.62 Lupus anticoagulant syndrome
D68.69 Other thrombophilia
D75.81 Myelofibrosis
D75.82 Heparin induced thrombocytopenia (HIT)
D75.89 Other specified diseases of blood and blood-forming organs
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
ICD-9 Codes that Support Medical Necessity
Group 1 Paragraph : It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
Group 1 Codes
289.81 PRIMARY HYPERCOAGULABLE STATE
289.82 SECONDARY HYPERCOAGULABLE STATE
415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION
415.12 SEPTIC PULMONARY EMBOLISM
415.13 SADDLE EMBOLUS OF PULMONARY ARTERY
415.19 OTHER PULMONARY EMBOLISM AND INFARCTION
444.9* EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY
451.0 PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES
451.11 PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN (DEEP) (SUPERFICIAL)
451.19 PHLEBITIS AND THROMBOPHLEBITIS OF OTHER
451.2 PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES UNSPECIFIED
451.81 PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN
451.82 PHLEBITIS AND THROMBOPHLEBOTIS OF SUPERFICIAL VEINS OF UPPER EXTREMITIES
451.83 PHLEBITIS AND THROMBOPHLEBITIS OF DEEP VEINS OF UPPER EXTREMITIES
451.84 PHLEBITIS AND THROMBOPHLEBITIS OF UPPER EXTREMITIES UNSPECIFIED
451.89 PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES
451.9 PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE
452 PORTAL VEIN THROMBOSIS
453.1 THROMBOPHLEBITIS MIGRANS
453.2 OTHER VENOUS EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA
453.40 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY
453.41 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY
453.42 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY
453.50 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY
453.51 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY
453.52 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY
453.6 VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITY
453.71 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY
453.72 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY
453.73 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED
453.74 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
453.76 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR VEINS
453.79 CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS
453.81 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY
453.82 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY
453.83 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED
453.84 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
453.86 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR VEINS
453.89 ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS
453.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED SITE
454.0 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER
454.1 VARICOSE VEINS OF LOWER EXTREMITIES WITH INFLAMMATION
454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION
454.8 VARICOSE VEINS OF LOWER EXTREMITIES WITH OTHER COMPLICATIONS
459.10 POSTPHLEBETIC SYNDROME WITHOUT COMPLICATIONS
459.11 POSTPHLEBETIC SYNDROME WITH ULCER
459.12 POSTPHLEBETIC SYNDROME WITH INFLAMMATION
459.13 POSTPHLEBETIC SYNDROME WITH ULCER AND INFLAMMATION
459.19 POSTPHLEBETIC SYNDROME WITH OTHER COMPLICATION
459.2 COMPRESSION OF VEIN
459.30 CHRONIC VENOUS HYPERTENSION WITHOUT COMPLICATIONS
459.31 CHRONIC VENOUS HYPERTENSION WITH ULCER
459.32 CHRONIC VENOUS HYPERTENSION WITH INFLAMMATION
459.33 CHRONIC VENOUS HYPERTENSION WITH ULCER AND INFLAMMATION
459.39 CHRONIC VENOUS HYPERTENSION WITH OTHER COMPLICATION
459.81 VENOUS (PERIPHERAL) INSUFFICIENCY UNSPECIFIED
518.81 ACUTE RESPIRATORY FAILURE
518.82 OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED
518.83 CHRONIC RESPIRATORY FAILURE
585.4* CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE)
585.5* CHRONIC KIDNEY DISEASE, STAGE V
585.6* END STAGE RENAL DISEASE
671.00 VARICOSE VEINS OF LEGS COMPLICATING PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.01 VARICOSE VEINS OF LEGS WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.02 VARICOSE VEINS OF LEGS WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.03 ANTEPARTUM VARICOSE VEINS OF LEGS
671.04 POSTPARTUM VARICOSE VEINS OF LEGS
671.10 VARICOSE VEINS OF VULVA AND PERINEUM COMPLICATING PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.11 VARICOSE VEINS OF VULVA AND PERINEUM WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.12 VARICOSE VEINS OF VULVA AND PERINEUM WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.13 ANTEPARTUM VARICOSE VEINS OF VULVA AND PERINEUM
671.14 POSTPARTUM VARICOSE VEINS OF VULVA AND PERINEUM
671.20 SUPERFICIAL THROMBOPHLEBITIS COMPLICATING PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.21 SUPERFICIAL THROMBOPHLEBITIS WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.22 SUPERFICIAL THROMBOPHLEBITIS WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.23 ANTEPARTUM SUPERFICIAL THROMBOPHLEBITIS
671.24 POSTPARTUM SUPERFICIAL THROMBOPHLEBITIS
671.30 DEEP PHLEBOTHROMBOSIS ANTEPARTUM UNSPECIFIED AS TO EPISODE OF CARE
671.31 DEEP PHLEBOTHROMBOSIS ANTEPARTUM WITH DELIVERY
671.33 DEEP PHLEBOTHROMBOSIS ANTEPARTUM
671.40 DEEP PHLEBOTHROMBOSIS POSTPARTUM UNSPECIFIED AS TO EPISODE OF CARE
671.42 DEEP PHLEBOTHROMBOSIS POSTPARTUM WITH DELIVERY
671.44 DEEP PHLEBOTHROMBOSIS POSTPARTUM
671.50 OTHER PHLEBITIS AND THROMBOSIS COMPLICATING PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.51 OTHER PHLEBITIS AND THROMBOSIS WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.52 OTHER PHLEBITIS AND THROMBOSIS WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.53 OTHER ANTEPARTUM PHLEBITIS AND THROMBOSIS
671.54 OTHER POSTPARTUM PHLEBITIS AND THROMBOSIS
671.80 OTHER VENOUS COMPLICATIONS OF PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.81 OTHER VENOUS COMPLICATIONS WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.82 OTHER VENOUS COMPLICATIONS WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.83 OTHER ANTEPARTUM VENOUS COMPLICATIONS
671.84 OTHER POSTPARTUM VENOUS COMPLICATIONS
671.90 UNSPECIFIED VENOUS COMPLICATION OF PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE
671.91 UNSPECIFIED VENOUS COMPLICATION WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
671.92 UNSPECIFIED VENOUS COMPLICATION WITH DELIVERY WITH POSTPARTUM COMPLICATION
671.93 UNSPECIFIED ANTEPARTUM VENOUS COMPLICATION
671.94 UNSPECIFIED POSTPARTUM VENOUS COMPLICATION
673.20 OBSTETRICAL BLOOD-CLOT EMBOLISM UNSPECIFIED AS TO EPISODE OF CARE
673.21 OBSTETRICAL BLOOD-CLOT EMBOLISM WITH DELIVERY WITH OR WITHOUT ANTEPARTUM CONDITION
673.22 OBSTETRICAL BLOOD-CLOT EMBOLISM WITH POSTPARTUM COMPLICATION
673.23 OBSTETRICAL BLOOD-CLOT EMBOLISM ANTEPARTUM
673.24 OBSTETRICAL BLOOD-CLOT EMBOLISM POSTPARTUM
682.3 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM
682.6 CELLULITIS AND ABSCESS OF LEG EXCEPT FOOT
695.9 UNSPECIFIED ERYTHEMATOUS CONDITION
707.10 UNSPECIFIED ULCER OF LOWER LIMB
707.11 ULCER OF THIGH
707.12 ULCER OF CALF
707.13 ULCER OF ANKLE
707.14 ULCER OF HEEL AND MIDFOOT
707.15 ULCER OF OTHER PART OF FOOT
707.19 ULCER OF OTHER PART OF LOWER LIMB
727.51 SYNOVIAL CYST OF POPLITEAL SPACE
729.5 PAIN IN LIMB
729.81 SWELLING OF LIMB
747.60 ANOMALY OF THE PERIPHERAL VASCULAR SYSTEM UNSPECIFIED SITE
747.61 GASTROINTESTINAL VESSEL ANOMALY
747.62 RENAL VESSEL ANOMALY
747.63 UPPER LIMB VESSEL ANOMALY
747.64 LOWER LIMB VESSEL ANOMALY
747.69 ANOMALIES OF OTHER SPECIFIED SITES OF PERIPHERAL VASCULAR SYSTEM
780.2 SYNCOPE AND COLLAPSE
782.2 LOCALIZED SUPERFICIAL SWELLING MASS OR LUMP
782.3 EDEMA
785.4 GANGRENE
786.00 RESPIRATORY ABNORMALITY UNSPECIFIED
786.03 APNEA
786.05 SHORTNESS OF BREATH
786.06 TACHYPNEA
786.09 RESPIRATORY ABNORMALITY OTHER
786.30 HEMOPTYSIS, UNSPECIFIED
786.39 OTHER HEMOPTYSIS
786.50 UNSPECIFIED CHEST PAIN
786.52 PAINFUL RESPIRATION
786.59 OTHER CHEST PAIN
790.92 ABNORMAL COAGULATION PROFILE
794.2 NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF PULMONARY SYSTEM
903.00 INJURY TO AXILLARY VESSEL(S) UNSPECIFIED
903.01 INJURY TO AXILLARY ARTERY
903.02 INJURY TO AXILLARY VEIN
903.1 INJURY TO BRACHIAL BLOOD VESSELS
903.2 INJURY TO RADIAL BLOOD VESSELS
903.3 INJURY TO ULNAR BLOOD VESSELS
903.4 INJURY TO PALMAR ARTERY
903.5 INJURY TO DIGITAL BLOOD VESSELS
903.8 INJURY TO OTHER SPECIFIED BLOOD VESSELS OF UPPER EXTREMITY
903.9 INJURY TO UNSPECIFIED BLOOD VESSEL OF UPPER EXTREMITY
904.0 INJURY TO COMMON FEMORAL ARTERY
904.1 INJURY TO SUPERFICIAL FEMORAL ARTERY
904.2 INJURY TO FEMORAL VEINS
904.3 INJURY TO SAPHENOUS VEINS
904.40 INJURY TO POPLITEAL VESSEL(S) UNSPECIFIED
904.41 INJURY TO POPLITEAL ARTERY
904.42 INJURY TO POPLITEAL VEIN
904.50 INJURY TO TIBIAL VESSEL(S) UNSPECIFIED
904.51 INJURY TO ANTERIOR TIBIAL ARTERY
904.52 INJURY TO ANTERIOR TIBIAL VEIN
904.53 INJURY TO POSTERIOR TIBIAL ARTERY
904.54 INJURY TO POSTERIOR TIBIAL VEIN
904.6 INJURY TO DEEP PLANTAR BLOOD VESSELS
904.7 INJURY TO OTHER SPECIFIED BLOOD VESSELS OF LOWER EXTREMITY
904.8 INJURY TO UNSPECIFIED BLOOD VESSEL OF LOWER EXTREMITY
904.9 INJURY TO BLOOD VESSELS OF UNSPECIFIED SITE
996.1 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.62 INFECTION AND INFLAMMATORY REACTION DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.70 OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT
996.71 OTHER COMPLICATIONS DUE TO HEART VALVE PROSTHESIS
996.72 OTHER COMPLICATIONS DUE TO OTHER CARDIAC DEVICE IMPLANT AND GRAFT
996.73 OTHER COMPLICATIONS DUE TO RENAL DIALYSIS DEVICE IMPLANT AND GRAFT
996.74 OTHER COMPLICATIONS DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.75 OTHER COMPLICATIONS DUE TO NERVOUS SYSTEM DEVICE IMPLANT AND GRAFT
996.76 OTHER COMPLICATIONS DUE TO GENITOURINARY DEVICE IMPLANT AND GRAFT
996.77 OTHER COMPLICATIONS DUE TO INTERNAL JOINT PROSTHESIS
996.78 OTHER COMPLICATIONS DUE TO OTHER INTERNAL ORTHOPEDIC DEVICE IMPLANT AND GRAFT
996.79 OTHER COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT
997.2 PERIPHERAL VASCULAR COMPLICATIONS NOT ELSEWHERE CLASSIFIED
997.79 VASCULAR COMPLICATIONS OF OTHER VESSELS
998.2 ACCIDENTAL PUNCTURE OR LACERATION DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED
999.2* OTHER VASCULAR COMPLICATIONS OF MEDICAL CARE NOT ELSEWHERE CLASSIFIED
V12.51 PERSONAL HISTORY OF VENOUS THROMBOSIS AND EMBOLISM
V67.00* FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY
V72.83* OTHER SPECIFIED PRE-OPERATIVE EXAMINATION
*NOTE: Use code 444.9 for paradoxical embolism;
*NOTE: use codes 585.4, 585.5 or 585.6 (secondary diagnosis) with code V72.83 for G0365; code V72.83 is covered only for CPT/HCPCS codes 93971 and G0365.
*Use V67.00 only to describe a limited venous duplex performed within 72 hours of a saphenous vein ablation procedure (36475, 36476, 36478, or 36479).
*Use code 999.2 for PHLEBITIS, THROMBOEMBOLISM COMPLICATIONS OF INFUSION THERAPY
ICD-9 Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-9 Codes that Support Medical Necessity” section of this policy.
The two sets of EVAT codes differ in terms of the energy modality used, but are otherwise identical. The initial vein treated is represented by a primary code and an add-on code is available to report the second and subsequent veins treated. Catheterization and all imaging guidance and monitoring are included and are not separately reportable. Thus, for example, neither CPT code 76998 (intraoperative ultrasound), nor CPT code 76937 (ultrasound guidance for vascular access) can be reported separately. In addition, it is not appropriate to bill for extremity venous duplex imaging (93970 – 93971) in conjunction with the EVAT unless a patient requires a diagnostic extremity Doppler ultrasound on the same day as the EVAT, in which case a modifier should be used to signify the provision of a separate and distinct service.
